ISSN0535-1405

No. 505

May 31, 2021
Published by International Medical Society of Japan,Chairman, Board of Directors: Kenichi Ishibashi, MD, PhD
Editors: K. Ito, MD, PhD, T. Kondo, MD, PhD,K. Ichihashi, MD, PhD, T. Murakami, PhD, R.Nagai, MD, PhD,
I. Taniguchi, MD, PhD, and T. Yamazaki, MD, PhD
3F MK Sangenjaya Building, 1-15-3 Kamiuma, Setagaya-ku,Tokyo154-0011,Japan.
TEL 03(5486)0601 FAX 03(5486)0599 E-mail: imsj@imsj.or.jp http://www.imsj.or.jp/

The 448th International Symposium on Therapy
The 448th International Symposium on Therapy was

In Lecture I, Mahito Mine, MD and the Director ofheld by the Zoom Webinar on March 18, 2021. Dr.

the Mine Pediatric Clinic will give us a lecture on theKo Ichihashi, Director of the International Medical"Circumstances of vaccination in Japan". He will

Society of Japan (IMSJ), presided over the meeting.

explain the current vaccination situation, as well as
various problems in the history of vaccination inChanges to and problems withvaccinations

Japan.

Hewillalsomention

theCOVID-19

vaccination situation.

Introductory Message from the Chair

In Lecture II, we will ask Ryo Konno, MD, PhD andProfessor in the Department of Obstetrics andKo Ichihashi, MD, PhD

Gynecology at Jichi Medical University Saitama

Director, IMSJ

Medical Center to give a lecture titled "the HPV

(Human papillomavirus) vaccine - Light and shadow
The theme of the 448th International Symposium on

in Japan and the world". He will talk about theTherapy

witheffectiveness of the HPV vaccine, how its inoculation

vaccinations". Vaccination is one of the most usefulrate is still low, as well as problems with it in Japan,

methods for preventing diseases; however, there

from the perspective of world standards.

is"Changes

toandproblems

are various problems regarding vaccination in
Japan and it is inadequately performed comparedto other countries. In recent years, it has become
possible for multiple vaccines to be regularly given,and rules on giving simultaneous vaccinations andrestrictions on vaccination time-intervals have beenrelaxed. Currently, vaccination against COVID-19
has started, so the general public is more and moreinterested in the effects and side reactions ofvaccines.

Page 7

International Medical Newsregular vaccination in other countries, the vaccines

LectureⅠ
Circumstances of vaccination in Japan
Mahito Mine MD
Directorthat are voluntarily vaccinated in Japan are themumps vaccine, meningococcal vaccine, andpediatric influenza vaccine. Is done.
In addition, the inoculation interval between

Mine pediatric clinic

different vaccines was also significantly different

Until a few years ago, the control status of VPD

2020. Under the Japanese vaccination system, until(Vaccine Preventable Disease) by vaccines innow, when different vaccines are given afterJapan was not sufficient. Measles was recognizedinactivated vaccination, there is an interval of 6

as an excluded country by the WHO in March 2015,

days or more. If different vaccines were given after

but rubella has been prevalent every few years,

all live vaccinations, there would be an interval ofespecially among men in their late 30s and 50s.

27 days or more. From October 1, 2020, it has been

Before October 1, 2014, when two vaccinations

changed to an interval of 27 days or more only

were scheduled, chickenpox occurred in about 1

when a different live vaccine is given after themillion patients each year. Around 2013, hepatitis B

injection of the live vaccine, which has been

was expected to cause more than 5,000 new

common in other countries for a long time. This isinfections each year, including mild and latent

expected to reduce the number of cases ofinfections. Until October 1, 2020, when the rotavirus

incorrect vaccination intervals, which had to be

vaccine was routinely inoculated, rotavirus

reported as incorrect vaccinations, by half.

gastroenteritis was the most common

In addition, even with the COVID-19 vaccine, whichgastrointestinal infection in children. Mumps is stillis currently being inoculated, it is necessary toprevalent every few years.

devise ways to inform medical personnel because

Here, I wi ll summa r ize the cha racter istics of

the inoculation procedure is intramuscular injection

infectious diseases in recent children in Japan. First

rather than subcutaneous injection, which isof all, the number of infectious diseases hascommonly performed in Japan. Normally, the maindecreased significantly, and the number of diseasesfocus is on sharing information on the effectivenesstargeted for routine immunization has decreased

and safety of vaccines and how to respond whendramatically. On the other hand, the mumps

adverse reactions occur, but in Japan, explanations

ep i d em i c co nt i n ues eve r y few yea r s. A sof intramuscular injection techniques andgastrointestinal infections, rotavirus infections areprecautions and practical training a re alsorare and norovirus infections are high. Influenza inrequi red. Also, at the inoculation site, manyc h i l d re n i s e n d e m i c a l m o s t eve r y ye a r. I t i sva cc i n e s a re g i ve n i n d i v i d u a l l y at m e d i ca lcharacterized by many respiratory tract infections

institutions in Japan, so mass inoculation tocaused by RS virus, human metapneumovirus,

inoculate many people in a short period of time,

mycoplasma, adenovirus, etc. In other words, itsuch as pandemic vaccines such as COVID19

can be seen that the incidence of VPD is greatly

vaccine, Inexperienced, information sharing andreduced by regular vaccination in infectious

training are required for these as well.

diseases in which the vaccine exists.

In this way, the situation regarding vaccines in

Certainly, the "vaccine gap" between Japan andJ a p a n s t i l l h a s m a ny p a r t s t h at d i f fe r f ro mother countries has improved considerably in moreinternational standards, and there are many

than 10 years. However, despite the fact that it is aproblems in terms of controlling VPD by vaccines. It

from the international standard until October 1,

Page 8International Medical Newsmay be necessary to regard the current situation inprevent the infection, the subsequent steps will notJapan as the perfect time to approach international

progress, and you can prevent the cancer.

standards at this time when the interest and(1) The efficacy of a domestic clinical trial and ( 2 )expectations for vaccines are increasing due tothe effectiveness of the HPV vaccine, which we

the COVID19 epidemic.

conducted for the cervical cancer screeing examinees of the Japan Cancer Society are shown below. Both are comparisons of HPV vaccinated andLectureⅡ

non-vaccinated women. (1)vaccine efficacy was

HPV (Human papillomavirus) vaccine- Light and shadow in Japan and theworld

evaluated on TVC naive (HPV uninfected women in
the total vaccine cohort) including 20-25 years old(vaccinated 254, unvaccinated 251) women, who
progressed CIN2 or more and CIN3 or more, respec-

Ryo Konno MD, PhD.

tively 74% (95% CI 1.1-95.3 ) and 100% (95% CI -417.0-Professor

100.0). On the other hand, (2) vaccine effectivenessDepartment of Obstetrics and Gynecology,

was investigated on 3,770 vaccinated women andJichi Medical University Saitama Medical Center

30,511 unvaccinated women, who progressed toWhat is National immunization program (NIP)? Vac-(95% CI 0.10-0.60) and 91% (95% CI 0.00-0.42). These

cination is for individuals and families, is resulted toresults are as good as (or better than) previous re-protect life and health in the country, then the mis-ports abroad, suggesting a sharp decline in thesion should be more efficient and effective for use

number of cervical cancer patients if vaccinationof financial resources.

continues in the future. In addition, recent our stud-

Recently, in Japan, the numbers of cervical cancer

ies suggested possible herd immunity. Herd effects

incidence and deaths increase, especially in young

are seen not only in unvaccinated women, but alsogeneration. In 2011, about 400 women under thein men in previous foreign reports. Then HPV vac-age of 44 died. Among the developed countries,

cine is recommended for both men and women up

Japan has the highest number of cervical cancer

to the age of 45 in the United States, and prevent-incidence and mortality, but this is because of theable cancers including anal and oropharyngeal

low screening coverage. Among Asian countries,cancers.

Japan was used to be a country with lower inci-

In April 2016, even before the regular vaccination ofdence and mortality owing to the early start of can-the HPV vaccine, just FAKE NEWS was taken up by

cer screening, but current incidence is the same as

the media, and it caused the drastic decrease ofIndia (14.7 per 100,000 population) and worse thanHPV uptake from 70% down to 0.1%. The reason is

China (10.7) and South Korea (8.4), respectively.

that the delay of governance of vaccine adminis-

The natural history of cervical cancer has been welltration without internationalization, and it resulted

elucidated. Most cervical cancers are caused by

not to make decisions based on the medical and

HPV infection. The four steps of cervical cancer arescientific grounds presented by WHO and others.

HPV infection, the development and persistence ofThe term of side reactions (effects) in Japan and in

precancerous lesions, progression to cancer and in-Japanese are used with confusion of adversevasion. Most women and men are infected withevents. Japan has not registration program of NIP

HPV at least once in their lifetime, but only few in-and does not grasp the background incidence offected people will develop precancerous lesions

prior to the vaccine program. The concerns of HPVand cancer. If you can get the HPV vaccine andvaccination program were the inaction of the crime

CIN2 more and CIN3 or more, respectively, 76%

Page 9International Medical Newsand will cause the worst tragedy due to the failure

1.400-year History and Hiya Kiogan

of vaccination governance.

First of all, our location has never changed atConclusion

Temma, Osaka for these 400 years. Why didn't it

HPV vaccine is highly effective and highly safe.
There is no reason to hesitate to be vaccinated because of FAKE NEWS with so-called side reaction.
Resurrection of proactive recommendation as soon
as possible. Relief for women up to the age of 26
who have missed or have not completed vaccination (catch-up as regular vaccination). Expandedchange?
In old times, people who finished their business at
the Dojima Rice Exchange, visited and worshiped
at Osaka Temmangu shrine, drank glasses ofTemma’s sake with the eel from the Yodo River as aside dish, crossed the Temmabashi bridge and took
passenger boats called “Sanjikkoku-bune” from thepier at Hachikenya-hama to go to Kyoto. Hiyaregular vaccination to gender neutral aged 12-26

Kiogan used to be sold for souvenirs before boarding

persons. We should learn a lot of lessons from HPV

the boat on the back approach of Osakaand COVID-19 vaccination and reform the nationalTemmangu.

immunization program.

Small, expensive and precious

medicines were ideal for souvenirs. So, many people
visited our shop to buy Hiya Kiogan from all overJapan, just like “Explosive Buying” by the borderless
visitors from overseas today. Therefore, our service

Discourseand dedication to Osaka Temmangu has been an

Introduction of the speaker of discourse
Ko Ichihashi, MD, PhD
Director, IMSJ
Takahiko (TK) Sakanoue, CEO & President of HIYA
Pharmaceutical Co., Ltd. will give us a lecture entitled "How to carry on 400 years of traditional business". It will be very interesting to listen to stories
about the roots of the well-known Hiya Kiogan andthe reason why they were able to continue theirbusiness for 400 years.

indispensable task.
The product name “Hiya Kiogan” consists of twoparts. One part is “Hiya”. In the Edo period, our shop
had a rain gutter on the roof-end to prevent
customers from getting wet in the rain. “Hiya” withthe meaning of “shop with rain gutter” became ourtrade name. “Kiogan” was named by expressing
how to improve symptoms. It means “medicine withoutstanding and satisfactory effects for various
diseases and symptoms. The original formulation ofKiogan was said to be brought to Japan by a priest
Ganjin (Jianzhen) in the 8th century.

Discourse: 400 Years of Traditional
Business & Key Points of Continuation

The formulation consists of natural plants andanimals, based on a Chinese medicinal theory.

Takahiko Sakanoue“Musk” is the secreted material of musk deer, which

CEO & President

is also used in perfumes such as Chanel #5. “Oriental

Hiya Pharmaceutical Co., Ltd.

Bezoar” is gallstone of cattle only fed with naturalpasture. In these days, its supply has become very

Our company has 400-year history of the household

tight due to the expected effectiveness on the

medicine "Hiya Kiogan" since our foundation in 1622

aftereffects of intracerebral hemorrhage in the(Genna 8).

Chinese medical industry. "Bear Bile" is bile acid ofI would like to talk about how this family business has

Brown Bear or Asian Black Bear bile acid, which isbeen continued in a changing era as well as thealso a main ingredient of Toyama's traditional

historical background.

medicines “Yutan-en” and “Hangontan” whichbecame famous in the 1690 Edo Castle Abdominal
Pain Incident. As herbal ingredients, "Ginseng" isInternational Medical News

widely used in health foods and "Agarwood" isfamous as a high-class incense.

2.What is the Key to Continuation?
In Japanese society, the birth rate has declined
significantly in these 75 years after World War II. The
birth rate of 1947 in the baby boom was more than
4 points (2.7 million births), but nowadays it stays
1.44 (0.94 million), decreased to 1/3. It would havebeen difficult to continue the business if we had just
kept doing the same thing.
Accordingly, we have made structural changes ofour company by clarifying “What should bechanged” and “What should NOT be changed”.
For instance, we have changed followings:
1) New product development
Widen product categories based on “HiyaKiogan” brandCold medicine, Chewable tablet for cough,Antipyretic suppository, Syrup medicine for cold& cough, etc.
Hiya Kiogan Gold for adults
Heart tonic pill for adult, “HIXINGAN”
characterized by Oriental Bezoar
2) New application development
Widen indications from current Hiya Kiogan(Night crying / Peevishness)
Clinical trial by Chinese medicine clinic inTaiwanex) Insomnia, Phobia (Panic, Anxiety),
Hyperactivity disorder, etc.
Clinical trial by E-da Hospital in Taiwanex) Improving impaired consciousness andshortening recovery period in patients withischemic stroke3) New Method of Information Provision & PR.
Newspaper, Magazine >> TV, Radio >> Internet,SNS
4) New Route of Information Provision & Supply
Sales in our Shop (Temma, Osaka)>> Sales through Distributors (Domestic DrugStores)>> Sales in internet / Cross-border e-commerce“What should NOT be changed” is brand andreliability.

Page 10

3.Conclusion
400 Years of Traditional Business & Key Points ofContinuation→Business operation by classifying “What should bechanged” and “What should not be changed”.
What should be changed:
Practical aspects such as products, uses,
contents & means of information, supply system,etc.
What should not be changed:
Traditional brand business of "Hiya Kiogan"
Keep building reliability for the brands
Thanks and gratitude to the received favors
I believe the above-mentioned is a basic principle
for every type of industry, and sincerely hope it willbe helpful to everyone at International Medical
Society of Japan.